The focus of this blog is on the wonders of government-run health-care everywhere but I also note the damage done to private medicine by a legal system that supports predatory litigation.

The long-established socialized medicine systems in Britain and Australia are a particularly relevant warning about where such systems end up.

Posts by John J. Ray (M.A.; Ph.D.)

Sunday, December 06, 2009

Lazy British paramedic lets baby die

Khalid Abdel-Rahim, a paramedic with the London Ambulance Service, faces being struck off by a conduct and competence committee at the Health Professions Council in London.

A panel heard Mr Abdel-Rahim responded to an emergency call at 2.25am on May 19 last year, accompanied by a newly-qualified female emergency medical technician. The patient, a pregnant woman, had had no ante-natal care, was not registered with a GP and refused to go to a hospital. She gave birth shortly after the crew arrived at the scene, but the baby was not breathing, the panel heard.

Chris Whalley, for the HPC, told the panel the technician, who was junior to the paramedic, attempted resuscitation, even though Mr Abdel-Rahim should have taken the lead. After about 15 minutes, Mr Abdel-Rahim made the decision to stop, although he did not have the authority to do so, the committee was told. Mr Whalley said: "He should not have made this decision and he did not have the authority to do so."

Mr Abdul-Rahim was also accused of a number of other failings, including that he failed to call for a second ambulance crew and midwife when it became obvious that birth was imminent. He also allegedly left the technician to attend to the patient and baby in the back of the ambulance when she was eventually persuaded to go to the hospital, when, as the paramedic, he should have attended to the patient himself.

And the committee heard that Mr Abdel-Rahim made a radio call to the hospital informing them incorrectly that there had been a miscarriage. This meant staff at the hospital were not properly prepared. On arrival, staff did attempt to restart the resuscitation, but the child was pronounced stillborn at 3.45am.

Mr Whalley said the HPC's case was that Mr Abdel-Rahim was guilty of a "serious lack of competence at best, serious misconduct at worst". The panel also heard evidence from assistant chief ambulance officer Steve Sale, who chaired a trust disciplinary panel, which looked into the incident. He said the crew arrived at a "chaotic scene", adding: "The patient herself was uncooperative, uncommunicative and did not wish to be examined by the crew at that time, so it was a difficult scene and a difficult call to respond to."

He said the technician persuaded the patient to allow an examination after building up some rapport, at which point it became clear that the birth was imminent. Mr Sale said, at this point, the paramedic should have called for a second ambulance and midwife.

Mr Abdel-Rahim, who did not attend today's hearing, was unable to tell the trust's own disciplinary panel why he did not do this.

The panel heard it was the technician herself who complained about Mr Abdel-Rahim's conduct because she was shocked when staff at the hospital tried to restart the resuscitation which the paramedic had stopped.

At the trust's disciplinary hearing, Mr Abdel-Rahim admitted allegations that he failed to resuscitate a new-born baby in line with guidance and training, but he said the scene was so chaotic that it clouded his judgment and thinking.

The HPC would not disclose the name of the hospital other than it was a large teaching hospital in London and the patient's address was less than a mile away.

The NHS is facing a 'perfect storm' of funding cutbacks, rising costs and increasing workload due to the ageing population, a think tank has warned. Health service managers and politicians must be honest about the scale of the financial challenges, the King's Fund has said in a report.

The NHS is faced with having to make efficiency savings of £20bn over three years from 2011 when the big funding increases come to an end. Yet demand for healthcare is increasing all the time with patients expecting better quality and a more responsive NHS and the ageing population requiring more care.

In the report Windmill 2009: NHS response to the financial storm, the King's Fund said it was vital that government and regional health service managers did not try to micromanage. Dr Anna Dixon, The King’s Fund Director of Policy, said: "It is clear that the NHS needs to start planning now and engaging staff and local people as it faces some difficult choices ahead. It’s vital that politicians are honest about the level of funding available and support local leaders in making these tough decisions."

The NHS budget has tripled under Labour but the big year-on-year increases were always planned to come to an end in 2011 with smaller rises after that. Now the recession and the government deficit have put increasing pressure on the NHS and some experts have warned there may even be a real terms cut in NHS funding as ministers seek to pay off the national debt.

Alasdair Liddell, report co-author, said: "There’s a danger that the recession will provoke the different organisations that make up the NHS to turn inwards and focus on their own survival as institutions rather than thinking about how they can work together to continue to provide the best service possible to their local communities. "That might require new partnerships and innovative ways of working with others, so this certainly isn’t the time for private and third sector providers to be dissuaded from getting involved in providing NHS services."

Karen Jennings, Head of Health at Unison, said: “The report is right to say that NHS leaders should be honest about the financial challenges ahead. It is also important for Trusts to recognise the valuable role that staff can play in unlocking improvements and driving up quality, particularly in a period of relative austerity. “And the report's findings on the advantages of working with the private sector do not come as a surprise, given the involvement of a number of private healthcare providers in producing it.

"That is what has generated so many off the wall and frankly damaging findings in the “Windmill” report. “The private sector does not have a monopoly on innovation. There are many examples of excellence within the NHS; what is needed is greater collaboration and sharing of that good practice."

Longevity apparently does not count for much in Britain's government-managed National Health Service.

Much of 108-year-old Olive Beal's hearing was gone. The one-time suffragette and former piano teacher from Kent, England was unable to enjoy music or hear conversations clearly with her five-year-old analog hearing aid. A modern digital device would improve Beal's hearing - and life - tremendously, but she was having difficulty receiving a replacement.

Beal's granddaughter, Maria Scott, explained: "Her analog hearing aid does not filter out background noise so it makes it very difficult for her to hear clearly. But the digital one would allow her to hear people talking to her and to CDs. She loves music hall numbers."

Beal was administered a hearing test in late July 2007, and a hearing expert recommended a digital hearing device. However, the local health authority, Eastern and Coastal Kent Primary Care Trust, has an 18-month waiting list for new hearing aids provided through the NHS. Despite her age and despite contributing income taxes that fund the government's universal health system into her late 60s, Beal was told she must wait her turn in line. A spokesman for the Eastern and Coastal Kent Primary Care Trust explained: "[P]riority is given to patients who do not have an existing hearing aid..."

Under the government system, Beal would be 110 years old by the time the new hearing aid was scheduled to arrive. Beal expressed her fear: "I could be dead by then."

Maria Scott added, "I would have thought they would take her age into account as she probably has not got 18 months to wait... Her eyesight is falling [sic], and if she cannot hear then she will be isolated from the outside world."

Fortunately, widespread press attention and concern about Beal's situation prompted Phillip Ball, a private audiologist, to assist Beal voluntarily. Ball said: "I can see no reason why a lady of her age should be fobbed off by her NHS Trust and told to wait at least 18 months, so I immediately got on the phone to offer my services. I visited Olive this week and she should have a fully functioning digital aid in a matter of days [early August 2007]. She will now be able to hear a great deal better."

A digital hearing device costs approximately 1,000 British pounds (~$1,600) each, and wait times for hearing aids can be over two years in some parts of Britain. "The new digital hearing aids can really transform people's lives," said Donna Tipping of the Royal National Institute for the Deaf, a British charity. "It is an issue of quality of life, with isolation, frustration and withdrawing from society caused by loss of hearing, and it is sad because this is reversible."

As her grandmother is one of Britain's oldest living citizens, Maria Scott added, "I thought a 108-year-old deserved to be treated better than this."

THE boss of the Brisbane Royal Children's Hospital approved thousands of dollars worth of luxury beauty treatments for nurses out of the hospital's charity fund for sick children, documents show. RCH district manager Doug Brown is being investigated over a $6500 bill for "pamper packages" at a Brisbane beauty salon, despite department financial guidelines prohibiting staff gifts, The Courier Mail reported.

The Royal Children's Hospital Foundation asks for donations to help support seriously ill kids, buy medical equipment and fund ground-breaking medical research. But an invoice obtained by The Courier-Mail shows Mr Brown approved its funds be used for 65 nurses to enjoy manicures, massages and body polishes at Skin Beautiful in the Queen St Mall two years ago.

The case is part of a wider Queensland Health ethical standards probe into Mr Brown, including his approval of an $8000 interest-free loan of taxpayer funds to a senior bureaucrat for personal overseas travel four months earlier. Mr Brown approved the loan to then director of allied health Gil Hainey despite guidelines banning loans to staff.

The beauty voucher issue allegedly involves a dispute with nurses during the relocation of oncology services from the Mater Children's Hospital at South Brisbane to the RCH at Herston in September 2007.

A group of about eight MCH nurses were allegedly offered six months' free parking at taxpayers' expense in the Metro Car Park at the RCH, despite the entitlement generally being given only to more senior medical specialists. But the plan allegedly backfired when nurses in the Banksia Ward at the RCH, led by a group known as the Oncology Steering Committee, learned of the parking perk and threatened industrial action. Mr Brown, who is listed as the board secretary of the RCH Foundation, allegedly tried to hose down the issue by organising with the nurses for 65 Ella Bache gift vouchers.

Queensland Health yesterday confirmed the bill was paid out of RCH Foundation funds, saying the money initially came from a district account before being reimbursed by the charity.

Director-general Mick Reid said the probe involved "alleged financial mismanagement in relation to car parking and alleged improper purchase of gift vouchers for staff". "Gifts to staff are in breach of the provisions of the Financial Management Practice Manual," he said. "I am treating this matter with the highest degree of seriousness and will act on all recommendations."

Mr Brown did not return calls. The probe is expected to be finalised and handed to the Crime and Misconduct Commission before the new year.

This week I asked four proponents of Obamacare to spend some time on air with me. Transcripts of these interviews with The New Republic's Jonathan Cohn, Brookings' economist Dr. Henry Aaron, Princeton economist Dr. Uwe Reinhardt and MIT economist Dr. John Gruber are all available here .

While I appreciate very much the willingness of Obamacare enthusiasts to come on air with an outspoken opponent of this radical and very risky scheme, I found the exchanges very frustrating, and many in my audience --especially practicing physicians-- found them outrageous. The problem is that each guest left many in the audience with the impression of not being forthcoming about the profound nature of the changes being proposed. I was sympathetic to the difficulty they found themselves in given the complexity of the legislation, but listeners sensed that these experts knew exactly the problems with the bill but simply were not in a hurry to level with them. My interview with Dr. Gruber, for example, took a long time to get around to the obvious point that Obamacare does nothing about the deep cuts scheduled for doctor reimbursement rates in 2010, cuts that everyone admits must be canceled, but which have been left uncorrected by Obamacare because their necessary correction would destroy the illusion of the bill's budget neutrality.

Similar verbal gymnastics occurred whenever the deep cuts in Medicare Advantage were discussed --the guests dismissed the idea that the inevitable benefit cuts were serious or would lessen the quality of life of the covered population-- or the impact of Obamacare's taxes on private insurance, or the risk the bill poses to the incentives for doctors to become doctors and practice the long hours they are presently used to practicing. A bill should not be that difficult to discuss, the impacts that hard to define or the cost impacts subject to such a wide array of estimates. As you read through the transcripts, take note of how often direct questions are met with convoluted answers or non-responsive asides, and sometimes with talking points.

At least one thing came through with complete clarity in my conversation with MIT's Gruber: Obamacare does nothing to halt Medicare's rapid march towards insolvency. Much of the public labors under a number of false impressions about Obamacare, one of which is that all the so-called cost controls of Obamacare and the massive cuts to Medicare will somehow work to keep the senior citizen healthcare program solvent when in fact they won't do anything of the sort. All of the debate and all of the effort are bringing forth only a massive new entitlement program with no fix whatsoever for the deeply broken health care entitlement programs that already exist.

Doctors listening to these exchanges throughout the week called or e-mailed their incredulity about the economists' naivete about conditions under which American doctors are presently practicing. Over and over again these doctors repeated the same dire warnings about the impact of Obamacare on the quality of American medicine. Professor Gruber dismissed such testimony as "anecdotal," but the volume and specificity of the accounts should give pause even to the most enthusiastic supporter of single payer. We are gambling with a system on which all of our lives depend, and Obamacare is pushing us to the edge of catastrophic breakdown.

Dr. Gruber candidly admitted that his view was that the "public option" wasn't that important but that abortion funding was. He also proclaimed the Massachusetts health care program a huge success and noted that Medicaid was deeply broken and leading to greater gaps in treatment for the poor. In other words, he has many opinions which are passionately held but which are either at odds with majorities of Americans or unaddressed by the Senate's version of Obamacare.

Here is one of the key exchanges of the week, and it is also with Dr. Gruber:

HH: Let me ask you to listen to a quote from President Obama made many times over the course of this year of debate.

JG: Okay.

BHO: Here’s a guarantee that’s I’ve made. If you have insurance that you like, then you will be able to keep that insurance. If you’ve got a doctor that you like, you will be able to keep your doctor.

HH: Can he make that guarantee?

JG: Yeah, he can, because the law has actually grandfathering provisions that say that literally, if you like, it’s literally in the law, there’s a grandfathering provision that says if you like your plan today, you don’t have to give it up.

HH: Is it true for people to believe that when their employer controls their health care decision?

JG: Well, their employer controls their health care decision today. So basically, I guess the issue is that, it’s always true today that your employer could drop your health insurance tomorrow. And under the bill, it’s true as well. So in some sense, that doesn’t change. The issue is really does this bill make that worse, and the answer is no.

HH: No, that’s not what he said. I’ll play it again, so that we hear it all clearly.

BHO: Here’s a guarantee that’s I’ve made. If you have insurance that you like, then you will be able to keep that insurance. If you’ve got a doctor that you like, you will be able to keep your doctor.

HH: Is that true, Jon Gruber?

JG: That statement played in that clip is not true.

HH: All right, that’s all…

JG: No, no, no. But let me finish. The statement that if you have insurance that you like this bill will not cause you to lose it. That’s a true statement.

HH: But that’s not the statement he made. The President sold this bill…

JG: But once gain, he was talking about a health insurance bill. He wasn’t talking about the world. He wasn’t saying I promise no one would ever lose their doctor, and that’s just, you know, that’s just parsing, that’s just trying to parse his language too fine. He was talking about a health care bill, and this health care bill will not cause you to lose your doctor or have to lose anything you like.

How many Americans are genuinely aware of what is in the bill? Of how it will impact them? Of how it will profoundly change the willingess of doctors to stay in practice or of young, talented college students to pursue a career in medicine?

And how many have been sold --by the president or others-- the false illusion that this is a comprehensive bill that will leave them with the health insurance they presently have and at least as good as a health care system as presently operates?

The answers are obvious. Hard for proponents of Obamacare to say, but obvious.

If you want to help stop Obamacare, visit and use this tool , and visit and contribute to ReverseTheVote.org . The future of American medicine is in the balance, and now is the time to speak up and speak out. Only if democrats fully understand the political fury that will follow their recklessness with American health care will they pull back from the brink.

The current form of the House bill with punish states with medical lawsuit caps

The U.S. Senate is debating health care reform. So far, there hasn't been any serious discussion about limiting the cost of medical malpractice lawsuits to save money for the health care system. The bill passed by the U.S. House is worse. It punishes those states, such as Michigan, that have adopted caps on "pain and suffering damages" and limit attorneys' fees in malpractice cases.

It would be entirely unreasonable for any bill that emerges from Congress that purports to reform health care to impose a cost on states' efforts to limit lawsuit costs.

More than two dozen states have adopted liability caps of some kind. This year, the general cap on pain and suffering damages in Michigan is $431,300, and the upper limit is $733,500. The caps are adjusted annually for inflation. Attorneys fees based on damages received in civil lawsuits are limited to a third of the total under Michigan court rules. The costs of continuing care and loss of income are still left to a jury to determine.

The caps were adopted in response to rising medical malpractice premiums. Relative to other Upper Midwest states, Michigan physicians were paying many more claims than their neighbors. Nationally, medical lawsuits have been estimated to impose billions of dollars in costs on the health care system.

The consulting firm Towers Perrin estimates that the national cost of medical malpractice suits was $30 billion in 2007. The Congressional Budget Office, the Wall Street Journal reports, has estimated savings from lawsuit limits at $54 billion over a decade, but Price Waterhouse Cooper, another consulting firm, has placed the cost of defensive medicine in the form of extra tests and procedures because of the threat of lawsuits at $240 billion last year.

Yet the House bill has a section that, while ostensibly encouraging alternative dispute resolution of medical lawsuits with "incentive payments" from the federal government, specifically bars any system with damage caps or attorney fee limits from eligibility for the incentive payments.

This section of the House bill is clearly more concerned with protecting trial lawyers than it is about controlling health care costs. That's not the kind of result Americans will be looking for in legislation claiming to reform health insurance and the health care system.

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Background

Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA

TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.

One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here